Higher Nighttime Diastolic Blood Pressure Research Articles

Effect of Aging and Hypertension on Ambulatory Blood Pressure, Arterial Stiffness, and Wave Reflection in Mid-life Adults

Introduction: Age-associated increases in blood pressure are partly due to increased arterial stiffness and wave reflection. How these vascular changes during aging contribute to daily fluctuations in blood pressure and hypertension remain to be elucidated. Therefore, the purpose of this study is to compare ambulatory blood pressure, arterial stiffness, and wave reflection between young healthy adults, mid-life adults without hypertension, and mid-life adults with hypertension. Methods: Twenty-five young (age: 26 ± 4 yr and body mass index [BMI]: 23.9 ± 2.5 kg/m2) and 31 mid-life adults (age: 57 ± 4 yr and BMI: 25.4 ± 2.6 kg/m2), free of obesity and major clinical diseases and non-smokers, were included. Hypertension was defined by the current use of anti-hypertension medications or offce seated blood pressure (BP) ≥ 130/80 mmHg. Young adults with hypertension were excluded. Twenty-four-hour ambulatory BP monitoring (Oscar 2™, SunTech Medical®) and assessment of aortic arterial stiffness and wave reflection (SphygmoCor XCEL, AtCor Medical) were performed in all participants. Results: Daytime, nighttime, and 24-hr systolic BP was similar between young adults (YA) and mid-life adults without hypertension (MA; n=12; P>0.9 vs. YA), while mid-life adults with hypertension (MAHTN; n=19) had higher offce, 24-hr, daytime, and nighttime systolic and diastolic BP compared to YA and MA (p<0.01 vs. YA and MA). Compared to YA, MA had higher nighttime diastolic BP (P=0.02). Aortic arterial stiffness, measured by carotid-to-femoral pulse wave velocity, was the highest in MAHTN (p<0.001 vs. YA and P=0<0.01 vs. MA), followed by MA (p<0.01 vs. YA) and YA. Aortic wave reflection, measured by augmentation index and reflection magnitude, was higher in MA and MAHTN compared to YA but was similar between MA and MAHTN (p<0.001 for MA vs. YA; p<0.001 for MAHTN vs. YA; and P>0.9 for MA vs. MAHTN). Conclusions: Our findings indicate that 1) mid-life adults with hypertension had higher ambulatory BP and arterial stiffness than mid-life adults without hypertension and young adults; 2) despite normal offce blood pressure, mid-life adults without hypertension had higher nighttime diastolic BP and arterial stiffness than young adults; and 3) regardless of hypertension, mid-life adults had higher wave reflection than young adults. These findings suggest that 1) vascular aging may present prior to the diagnosis of hypertension based on offce BP; 2) arterial stiffness, rather than wave reflection, may contribute to the development of hypertension during aging; and 3) compared to offce BP, ambulatory BP may be a more sensitive marker of age-associated increases in blood pressure. NIAAA K99/R00 AA028537 to CLH. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

P0150EFFECT OF SEROTONIN REUPTAKE INHIBITORS (SSRIS) AND SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) ON BLOOD PRESSURE VARIABILITY USING 24 HOURS AMBULATORY BLOOD PRESSURE MONITORING

Abstract Background and Aims Hypertension (HTN) and psychiatric disorders frequently co-exist in general population. Serotonin re-uptake inhibitors (SSRIs) and serotonin-norepinephrine re-uptake inhibitors (SNRIs) affect serotonin and norepinephrine and may lead to variation in blood pressure (BP). There is paucity of data on blood pressure variations using 24 hours ambulatory blood pressure monitoring (ABPM) with the use of SSRIs/NSRIs. Method Subjects who underwent psychiatric evaluation and ABPM within six month of each other between 1/1/2012 to 12/31/2016 at Mayo Clinic Florida were identified using billing data. Demographics, co-morbidities, medications, ABPM, and laboratory results were retrospectively collected from medical records. Subjects were divided into groups – subjects with no psychiatric diagnosis and no psychiatric medicine (Group 1) and subjects with psychiatric diagnosis and on SSRIs/NSRIs (Group 2). BP systolic and diastolic levels (day time, night time) were compared between groups controlling for age, sex, race, presence or absence of HTN, diabetes mellitus (DM) and smoking. Single and multivariable linear regression models were used to analyze group differences. Results Total of 367 subjects met inclusion criteria – Group 1=135; Group 2=232. The subjects in group 2 were older (median age 57 yrs vs 47 yrs p<0.001), white (69.8 vs 60% p=0.002), smokers (15.9 vs 3.0% p<0.001), history of HTN (62.5 vs 9.6%), and DM (21.1% vs 0%). ABPM showed that subjects in group 2 had higher median daytime systolic BP (131 vs 124), higher median night time systolic BP (120 vs 110), and higher median night time diastolic BP (68 vs 63). Multivariable linear regression controlling for age, sex, race, presence or absence of HTN, DM, and smoking showed that use of SSRIs/NSRIs (group 2) was significantly associated with higher night time systolic BP (8.36 mm; 95% CI 4.2, 12.5; p <0.0001) and higher night time diastolic BP (4.6 mm, 95% CI 1.9, 7.29, p=0.001). On subgroup analysis comparing subjects with use of SSRIs vs NSRIs, there was no statistically significant difference in the daytime or night time systolic or diastolic BP. Conclusion Use of SSRIs and NSRIs are associated with higher nocturnal systolic and diastolic BP, which can potentially increase the risk of adverse cardiovascular outcome in this population. Higher nocturnal BP may be due to ongoing sympathetic activation during sleep with serotonin and norepinephrine with the use of SRRIs and NSRI. Further well designed prospective studies using ABPM are needed to determine the risk of nocturnal hypertension with the use of SSRIs/NSRIs that could have potential adverse cardiovascular outcome.

Isolated nocturnal hypertension and arterial stiffness in a Chinese population

We reported previously that normotensive Chinese had higher nighttime diastolic blood pressure (BP) compared with non-Chinese. We, therefore, studied the prevalence and characteristics of isolated nocturnal hypertension and its association with arterial stiffness, an intermediate sign of target organ damage. We recorded ambulatory BP, the central and peripheral systolic augmentation indexes, the ambulatory arterial stiffness index, and brachial-ankle pulse wave velocity in 677 Chinese enrolled in the JingNing population study (53.6% women; mean age: 47.6 years). The prevalence of isolated nocturnal hypertension (> or = 120/70 mmHg from 22 : 00 to 4 : 00 h) was 10.9%. Patients with isolated nocturnal hypertension, compared with participants with ambulatory normotension (45.8%), were older (53.7 vs. 40.7 years), more often reported alcohol intake (68.9 vs. 51.0%), and had faster nighttime pulse rate (62.8 vs. 60.7 bpm), higher serum cholesterol (5.12 vs. 4.77 mmol/l), and higher blood glucose (4.84 vs. 4.38 mmol/l). They also had higher indexes of arterial stiffness (P<0.05) than participants with ambulatory normotension. Of 74 patients with isolated nocturnal hypertension, only four (5.4%) had hypertension on conventional office BP measurement (> or = 140/90 mmHg). Isolated nocturnal hypertension can only be diagnosed by ambulatory BP monitoring, is prevalent among Chinese, and is associated with increased arterial stiffness.

Is Isolated Nocturnal Hypertension a Novel Clinical Entity?

We reported previously that normotensive Chinese had higher nighttime diastolic blood pressure compared with non-Chinese. We, therefore, studied the prevalence and characteristics of isolated nocturnal hypertension (HT) and its association with arterial stiffness, an intermediate sign of target organ damage. We recorded ambulatory blood pressure, the central and peripheral systolic augmentation indexes, the ambulatory arterial stiffness index, and brachial-ankle pulse wave velocity in 677 Chinese enrolled in the JingNing population study (53.6% women; mean age: 47.6 years). Prevalence was 10.9% for isolated nocturnal HT (>or=120/70 mm Hg from 10:00 pm to 4:00 am), 4.9% for isolated daytime HT (>or=135/85 mm Hg from 8:00 am to 6:00 pm), and 38.4% for day-night HT. Patients with isolated nocturnal HT, compared with subjects with ambulatory normotension (45.8%), were older (53.7 versus 40.7 years), more often reported alcohol intake (68.9% versus 51.0%), had faster nighttime pulse rate (62.8 versus 60.7 bpm), had higher serum cholesterol (5.12 versus 4.77 mmol/L), and had higher blood glucose (4.84 versus 4.38 mmol/L). Similar to patients with isolated daytime HT or day-night HT, patients with isolated nocturnal HT had higher indexes of arterial stiffness (P<0.05) than subjects with ambulatory normotension (central augmentation index: 140% versus 134%; peripheral augmentation index: 82.6% versus 76.5%; ambulatory arterial stiffness index: 0.40 versus 0.35 U; brachial-ankle pulse wave velocity: 16.2 versus 14.7 m/s). Of 74 patients with isolated nocturnal HT, only 4 (5.4%) had hypertension on conventional office blood pressure measurement (>or=140/90 mm Hg). In conclusion, isolated nocturnal HT can only be diagnosed by ambulatory blood pressure monitoring, is prevalent among Chinese, and is associated with increased arterial stiffness.

Clinical Relevance of Nighttime Blood Pressure and of Daytime Blood Pressure Variability

The purpose of this study was to assess whether hypertensive target organ damage is related to average nighttime blood pressure (BP) and to BP variability. Sixty-seven normotensive subjects and 171 borderline, 309 mild, 140 moderate, and 41 severe hypertensive patients were studied with noninvasive ambulatory BP monitoring. Each subject was assigned a target organ damage score of 0 to 5 on the basis of funduscopic changes and degree of left ventricular hypertrophy calculated from electrocardiogram and chest roentgenogram. When the 728 subjects were subdivided into five classes of increasing daytime BP, in each class a significantly higher degree of target organ damage was present in the subjects with higher nighttime diastolic BP. A similar, although nonsignificant, trend was observed in the subjects with higher nighttime systolic BP. In particular, higher nighttime BP levels were accompanied by a more severe degree of left ventricular hypertrophy. As for variability, subjects with higher daytime systolic BP SD, but not with higher daytime diastolic SD, displayed a more severe degree of target organ damage; this was accounted for by a higher degree of retinal abnormalities. The association between target organ damage and systolic BP SD was present both in men and women, while that with nighttime BP was present only in men. No relationship was found between degree of cardiovascular complications and peaks of pressure. These results suggest that a reduced day-night BP difference and an increased daytime BP variability, evaluated as the SD, are associated with a higher degree of hypertensive cardiovascular complications. Whether this BP profile is the cause or the consequence of target organ damage remains to be established.